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General NPI Number Information
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NPI Number | 1174341184
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Entity Type | Individual
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Provider Name | JOHN DOUGLAS BUTGEREIT
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 3051 SANDY PLAINS RD
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City | MARIETTA
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State | GA
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Zip | 30066-4721
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Country | US
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Telephone | 770-977-7661
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Fax |
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Provider Business Mailing Address
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Address Line | 107 LAGUNA SPRINGS DR
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City | WOODSTOCK
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State | GA
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Zip | 30188-3039
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Country | US
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Telephone | 404-977-9147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH035126
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License Number State | GA
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